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Life at the Bottom, by Theodore Dalrymple. Ivan
R. Dee, 2002, 263 pages.
Living and Dying in Socialist
Britain by John Clark
Ronald Reagan once said that socialism works in only two
places: heaven, where they don"t need it, and hell, where they"ve already got it.
In his day the world"s socialist exemplar was the Soviet Union, founded on the
principle of abolishing private property by all means, at any cost. This
experiment was a fair success according to its own purpose. Whether Soviet
citizens got a decent life out of it is another question, and not a difficult one
to answer. When that regime collapsed in about its 74th year, there was nothing
of value to show for such continuous, massive poverty, pollution, famine,
torture, and death.
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Clark is a title insurance specialist living in Seattle.
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British socialism had the less extreme and nobler-sounding goal of providing
for the bodily needs of all its subjects. In this ideal society, no one would
have to worry about going hungry or homeless or untended. According to Theodore
Dalrymple, in "Life at the Bottom," this socialism has been quite a success
according to its purpose. There is today, he notes, almost nothing that a British
resident can do to relieve the state of its obligation to feed, house, entertain,
and care for him.
As a physician in a British inner-city hospital and prison, Dr. Dalrymple has
observed as much of the socialist reality as any person can — not just at
his workplaces but also in many homes, streets, public areas, and from
interviewing some 10,000 patients over the years. What is this reality like? When
the state provides for everyone"s needs regardless of effort or conduct on their
part, far too many people see no need to learn about the past, use their time
well in the present, or plan for the future. "A system of welfare that makes no
moral judgments in allocating economic rewards promotes anti-social egotism."
This is what we see —Êan ignorant, coarse, slovenly, filthy, lawless caste
of socialist "beneficiaries" and others who suffer their abuse and harm.
There is always a danger that a policy of insurance will promote the behavior
or condition that it insures against; this is what economists call "moral
hazard." It is much in evidence in all aspects of British society today. Those
socialists either were blind to the moral hazard or regarded themselves as exempt
from, or even the authors of, the law of nature. Egotism begets egotism and, per
Dalrymple, "misery increases to meet the means available for its
alleviation."
The more health care is viewed as a "right," to be consumed by oneself and
paid for by others, the more widespread, inevitably, become smoking, gorging,
boozing, doping, snorting, and other unhealthy behaviors. Typically, several
patients a day are admitted to Dr. Dalrymple"s hospital having "attempted"
suicide by sub-lethal overdose for, among other reasons, the benefit of a free
hospital stay. Far from appreciating this care, many such patients are abusive
and threatening to the physicians, nurses, and staff who provide it. Visiting
physicians from India and the Philippines who at first admire the socialist ideal
are soon appalled by the reality. "On the whole," says one, "life is preferable
in the slums of Manila." |
| There is today, he
notes, almost nothing that a British resident can do to relieve the state of its
obligation to feed, house, entertain, and care for him.
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A less obvious result of the moral hazard of health care as a "right" is
increased violence in general. Why should one refrain from punching, clubbing,
stabbing, or shooting another person when the system is always there to put the
damage right? Combined with other incentives to lawlessness such as the dole, a
worthless school system, and lax policing, Britain has some of the world"s
highest rates of theft, robbery, and assault — and even the highest rates of
such crimes with firearms, despite ("despite") strict gun-control laws.
In a recent column, April 8, Molly Ivins denounced America"s health-care
system as "stupid" and "falling apart." Her solution, of course, is to replace it
with a socialized system like Britain"s. Fine — Dalrymple gives her and
like-minded people a chance, if they"ll be so honest with themselves, to learn
how their ideal functions in reality. Americans have no experience with
socialized medicine, so they are mostly pretty ignorant about it. Its advocates
are ignorant even of their ignorance.
Britain"s knowledge dates from the founding of their National Health Service
in 1948. Thirty years later, economist Milton Friedman noted that while the
population had grown since then, the total number of hospital beds had declined.
Health-care bureaucrats have said at times that the lost capacity for treating
the sick and injured was not needed anyway. Yet it"s hard to believe that growing
numbers of elderly require less health care year by year, while on the other hand
so much is expended on drunks, junkies, and brawlers who regard hospital care as
their "right."
As sure as any natural law, this incentive to neglect and abuse one"s own
health will lead many people to do so, in every way possible. Inevitably these
derelicts will require income support and subsidized housing and jail and prison
cells as well. That is one lesson of Dalrymple"s book. Why, in America, suppose
that our bumbling amateurs can avoid all of the experts" mistakes?
We have better options than to grant power over our lives to amateurs,
experts, or whomever. One is to take primary charge of our own health. This means
following the rules of nutrition, fitness, and hygiene that any 6th grader or the
surgeon general can learn. It may mean paying directly for routine services that
we want and buying our own insurance policies for services that we hope we"ll
never need (e.g., surgeries and hospital stays). And instead of relying on the
government to tax us to pay for our health care, we can offer to share our own
wealth with the poor and those who serve them.
The more we can learn from others" experience, the less time and money we will
waste and the less misery we will suffer. Dalrymple has done an invaluable
service by telling the stark truth about socialized medicine. So compelling is
"Life at the Bottom" that I read it cover to cover in a day"s time — and
later reread it twice.
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